The Bipolar-ADD/ADHD Connection, Part I - Paying Attention to Attention

Patient Expert

This is the first in our conversation on the overlap between bipolar and ADD (or ADHD). Let's get right into it ...

You know how it goes down. It's late evening, you're starting to droop, big day tomorrow, time to hit the hay. But first, five minutes to check out Facebook. Someone's just posted "Ten Reasons Why Rednecks Make Bad Astrophysicists." You decide you need a good laugh. You click to the full piece. It's hilarious. You're laughing your ass off. You can't stop now, of course. You click on the link to "Seven Great Disasters in History Caused By Men Who Didn't Ask for Directions."

Inside your brain, your dopamine circuits are firing. The thinking parts of your brain lock in. You are alert and hyper-focused, but at the expense of any awareness of your immediate world and what you need to be doing to negotiate your way through it. All sense of time vanishes.

Meanwhile, the feeling parts of your brain light up at the anticipation of pleasure and reward. This is the same dopamine rush that novelty-seekers and drug-abusers alike crave - or for that matter people who lead perfectly healthy lives.

Sleep? Forget it. But the novelty is starting to wear off, the dopamine isn't zapping with the same intensity. You're not laughing as hard, but you still need your fix. You click to Seven Things Men Need to Know About What Women Talk About in Restrooms ...

By now, things are getting tedious. But stop? You can't.

Two hours later (has it been that long?), you drag yourself into bed. If you're lucky you go right to sleep. But if you're like most of us reading this, your mind is racing. You won't be nodding off any time soon. You need to be fully on your game for your big day tomorrow, and that simply is not going to happen. As if that is not bad enough, your sleep cycle - the key to keeping your moods in check - has been thrown seriously out of whack. You are now facing a week or more of living very dangerously.

Let's turn up the heat a bit. This time it's a project rather than an idle activity. You have a brilliant idea for a book chapter, "Paris Hilton Goes to Harvard." You get crackin'. Next thing, it's four in the morning and you need to be at work - on your game for your big day - at eight. Not going to happen.

Okay, let's flip the scenario around a bit. This time you click to "Ten Reasons ..." only to experience the sensation of Reasons Three through Ten fading from view. Something else is competing for your attention, International World Garbage Collection Day, which sounds like a worthy cause that you need to be donating to right now, but first an important text message, but hold on, something about tax deadlines (no, forget that, tomorrow maybe), wait, is that a lightning bug?

"I'm supposed to be doing something important," a voice inside your head may be telling you in the middle of all this, but what? Oh, yeh, the financials for your big presentation at work tomorrow. You pull up the financials, but they may as well be in Chinese. You feel frustrated and powerless. Experience this enough times and the brain becomes conditioned to a state of learned helplessness, rendering you a sitting duck for depression.

Either way, hyper-focused or barely focused, the brain (perhaps momentarily) has lost its capacity to direct its attention. Either way, ADD meets bipolar. Either way, bad things happen.

But wait. Hold your horses. We've all spent way too much time on Facebook or working late into the night on a project. Likewise, we've all experienced those times when our brains bounce from one thing to the other or we forget things or procrastinate. That doesn't mean we have ADD, do we?

True. But that hardly lets us off the hook, either. Thinking in terms of diagnostic thresholds lulls us into a fool's paradise of believing there is nothing wrong with us. Whether it's bipolar or ADD or anxiety or any other condition, it's never a question of "do you have it?" or "don't you"? Rather we're talking about "how much do you have?" or "how little"?

So - how much ADD do you have? We all have issues with directing our attention. Often, this can be advantageous. Einstein famously came up with his earth-shaking realizations when he was daydreaming and probably supposed to be taking out the trash. But he also had what it took to keep his mind on task, to get past the "E" en route to E=MC2.

But suppose you are so hyper-focused on the "E" that you can't see your way to the other side of the equation? Or maybe your under-focus sabotages your ability to even keep your head in E.

Been there, done that? Maybe you have ADD, maybe you don't. But there is obviously an attention thing going on, something that can seriously throw you off your game, something that can seriously make your bipolar more difficult to manage. Thus (take home message, here) you need to paying attention - to attention.

Much more to come ...

For the ADD side of the equation in this series of posts, I am relying very heavily on my friend Gina Pera's highly original book, "Is It You or Me or Adult ADD?" Please check out her exceptionally provocative and riveting blog, The ADHD Roller Coaster.

I am also working off of Eileen Bailey and Donald Haupt's very informative and straightforward "The Complete Idiot's Guide to Adult ADHD." Eileen is a fellow Health Guide here at HealthCentral, with extremely useful posts on ADHD.

For the bipolar side of the equation, I am largely connecting my own dots based on my research into how the brain processes information, focuses attention, modulates impulses, and responds to dopamine. I am also guided by the comments of my readers in response to a recent Question of the Week.